Faculty Bibliography

For the handful of patients I cannot reassure, who continue to believe that they have anthrax or insist on medication for anthrax, there is only one thing I can do. I am compelled to admit that there is one condition that can mushroom beyond any physician's ability to intervene--a condition fueled by speculation, resistant to all treatment including antibiotics. The main risk is still psychological. To calm the panic, sometimes it is necessary to administer tests to prove to a patient that he doesn't have the disease. I am against unnecessary antibiotics, but I am for increased surveillance. Our laboratories must gear up to handle more nasal swabs and antibody tests for anthrax. For years I have been checking HIV antibodies on patients with almost no risk just so their dating lives could be more comfortable

What the drug company is not telling either patient or doctor is that [Cipro] was originally tested as an alternative treatment for anthrax only for penicillin-allergic patients. Antibiotics have never been properly tested for prophylaxis, so Cipro's usefulness for prevention is speculative, though there is clearly some rationale for prophylaxing patients with close exposure. But doxycycline, a generic, is just as effective and costs one-tenth of what Cipro costs. A month's supply of Cipro costs more than $300 US; the equivalent amount of doxy is $32

Under the lights of my examination room, I realized that it was his manner that had altered the most; formerly confident, even strident, now he leaned against the counter, not wanting to sit. He hunched over, wringing his hands, looking every few seconds toward the window. In my consultation room I explained to the patient that the risks of taking this expensive antibiotic for an extended period far outweighed any potential benefit against an inconceivable microbe; that with prolonged use of the medicine he might develop diarrhea, colitis, rash, even bleeding or insomnia. ''Wait,'' I said. But he ignored me. He was heading for my supply closet at the front of the office. Without hesitation, he began rummaging through it. My nurse, who had never before seen a patient so boldly enter a private area of the office, seemed afraid to intervene. The patient knocked over pill boxes until he found the antibiotic he was looking for, and then he stuffed it into his pockets until my supply was exhausted. He left the office then, without saying goodbye to anyone

We health-care workers comfort and support one another, working as a unit. Firefighters and EMS workers ranging deeper into the rubble than they should have their eyes washed free of smoke by doting surgeons, and everyone who is injured in the cause is whisked away to St. Vincent's hospital or Bellevue for emergency treatment. Sign-up lists are filled with the names of nurses who work their regular shifts at the hospital and then volunteer to staff emergency centers in their free hours. Doctors fill the emergency rooms and help patrol Ground Zero without regard to previous rank or position in the medical community. There has been an overwhelming response to requests to the public to donate blood

Siegel comments on the exorbitant costs of prescription drugs. He discusses the current system's inability to consistently provide for a patient's medical needs.

I knocked on the door, entered and found Tito Puente alone. He seemed comfortable, but nervous. I told him that I had been sent to see him by his manager, who was a patient of mine. Tito nodded. He'd been expecting me, he said. He looked healthy; sometimes it was a matter of subtle perception to differentiate who needed an operation from who didn't. I went downstairs to speak with his relatives. They were holding a vigil near the elevators where families traditionally waited for the surgeon to bring them the news. In Tito's case, the surgeon was still in there with him, trying to treat the unforeseeable bleeding disorder. For almost 10 hours he'd been there with his patient, unwilling to take a break. I arrived there at the same time as the pizza man, bringing the family more sustenance than I could. 'It doesn't look good,' I said, something they already knew. I recognized Tito's daughter from the TV and, as she jounced up to pay the pizza man, I could again see her father's energy. I drew a picture of the heart and showed Tito where the valve was that was damaged. It was a straightforward operation to repair it and, if the vessels that fed the heart its blood and oxygen were blocked, a bypass operation would be performed at the same time. Tito was nervous about the operation. He was used to exerting maximal control over his life, his music. Now he would be handing all this over to a stranger, a man who, in a different world, was also a control artist, working long hours with maximal attention and focus, a man who was also known for his great hands

The case of a 35-year-old woman who reported to Siegel with abnormal and sometimes missing periods is recounted. The diagnosis was premature menopause

Siegel discusses the unusual case of Sandra, a diabetic woman who suffered from extreme multiple personality disorder. It seemed as though Sandra's many different personalities had varying blood sugar levels

President Bill Clinton's plan separates doctors only by specialty. It makes no allowance for a doctor's experience or motivation. A great many of us still see ourselves as healers, driven by compassion and altruism rather than greed. Yet the president's plan will punish the doctors who are not now overpaid. Is a patient justified in resenting a doctor for profiting for his or her dependency? Contrary to popular belief, most of us are not golf-playing land barons. The question is: Will I be able to maintain the same interest under the proposed system of government curtailment and control? And will reducing my income somehow cure the problem? Patient A is an AIDS patient who lost his medical insurance three years ago when he was deemed 'high risk' by his insurance carrier. I continued to treat him without charge, although he was a difficult and abusive patient. After countless narrow escapes with death, Patient A has now developed a regard for me that is matched only by the gratification I feel at taking care of him. He has also acquired Medicaid, which means that I can charge him a whopping $7 a visit if I choose to do the paperwork. Under the proposed new system of health care, Patient A may no longer be able to choose me for his doctor at all